Jim L. Story

Loss of heterozygosity on chromosome 10 in human glioblastoma multiforme

Recessive mutations, revealed by loss of the wild-type allele, have been associated with the development of a variety of cancers in children and adults. Polymorphic chromosome 10 markers were used to screen paired tumor and lymphocyte DNA samples in 13 patients with glioblastoma multiforme. Ten patients showed loss of constitutional heterozygosity in the tumor samples. This finding suggests that a recessive gene involved in the development of glioblastoma multiforme is present on chromosome 10.

Multifocal cavernous hemangioma of the skull: report of a case and review of the literature.

Primary hemangiomas, which are rare skeletal tumors, represent 0.7% of all osseous neoplasms. They are most commonly found in the vertebral column. They are exceedingly rare in the calvarium, accounting for 0.2% of all bone neoplasms. Most calvarial lesions are unifocal, but multiple hemangiomas have been reported. We present the case history of a 64-year-old man who was admitted with frontal and occipital headaches. He was found to have two radiolucent lesions on plain x-ray, left frontal and left occipital, which proved to be cavernous hemangiomas. The gross appearance, histopathology, radiological findings, and treatment options are reviewed.

Cerebral revascularization: common carotid to distal middle cerebral artery bypass

A right common carotid to distal middle cerebral artery bypass utilizing a saphenous vein graft was performed in a patient with episodic cerebral ischemia and reversible ischemic neurological deficit. The patient was relieved of his symptoms, and there was improved motor function in the left hand. Postoperative angiography revealed flow through the graft with excellent filling of the middle cerebral circulation, both retrograde and antegrade. This bypass procedure provided an immediate source of high volume blood flow and thereby provided immediate protection to the hemisphere.

Aneurysms of the persistent hypoglossal artery.

The primitive hypoglossal artery is one of four embryonic anastomoses between the carotid and basilar arterial systems. The so-called persistent hypoglossal artery is most likely a complex vessel comprised proximally of a persistent hypoglossal artery and distally of components of the primitive lateral basilar-vertebral anastomotic network. This is the sixth reported case of an aneurysm of the persistent hypoglossal artery, and it is unique in its association with two supratentorial aneuryms, one of which had ruptured. All three aneurysms were treated by a direct surgical approach (two operations). Review of the other published cases demonstrates that these aneurysms arise at the junction of the persistent hypoglossal with the basilar artery. Aneurysms of this vessel require direct surgical treatment, because the parent vessel is functionally the only artery supplying the brain stem and therefore may not be ligated. The aneurysms usually lie in the subarachnoid space, indenting the brain stem, and may be approached through a suboccipital craniectomy.

Cerebral revascularization: proximal external carotid to distal middle cerebral artery bypass with a synthetic tube graft.

A right proximal external carotid to distal middle cerebral artery bypass with a prosthetic tube graft was performed in a patient with intermittent cerebral ischemia due to middle cerebral artery stenosis. The patient was relieved of his symptoms, and he was neurologically normal 3 months after operation. Angiography 3 months postoperatively revealed flow through the graft and excellent filing of the middle cerebral circulation, both retrograde and antegrade. Early results suggest that an expanded polytetrafluoroethylene graft may be useful as a vascular conduit if suitable autogenous vessels are unavailable or have failed.

Subclavian steal syndrome

Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition. Neurological symptoms were relieved or improved in all three, with no decrease in blood pressure or pulse in the ipsilateral upper extremity. The colorful history of this syndrome is reviewed, and the various surgical approaches to its treatment are discussed. Although the literature suggests that the commonly used carotid to subclavian artery bypass graft and other similar extrathoracic procedures are generally safe and effective for relief of symptoms of the steal, there is also evidence that these bypasses may fail to restore antegrade flow in the vertebral artery, and, in fact, may steal from the carotid artery. Thus, the blood flow provided to the brain by these procedure may be hardly more than that provided by vertebral artery ligation, whereas the principal effect is to restore blood flow into the upper extremity. Vertebral artery ligation alone has been used in 20 patients, with neurological improvement in all cases and production of persistent intermittent brachial claudication in only one. These considerations and our patient experience suggest that a relatively simple operation, proximal vertebral to common carotid artery transposition, which emphasizes restoration of flow to the brain rather than to the upper extremity, may be preferable for most patients with neurological symptoms of subclavian steal syndrome.

Multifocal Cavernous Hemangioma of the Skull

Primary hemangiomas, which are rare skeletal tumors, represent 0.7% of all osseous neoplasms. They are most commonly found in the vertebral column. They are exceedingly rare in the calvarium, accounting for 0.2% of all bone neoplasms. Most calvarial lesions are unifocal, but multiple hemangiomas have been reported. We present the case history of a 64-year-old man who was admitted with frontal and occipital headaches. He was found to have two radiolucent lesions on plain x-ray, left frontal and left occipital, which proved to be cavernous hemangiomas. The gross appearance, histopathology, radiological findings, and treatment options are reviewed.

Cerebral revascularization with an artificial graft: Long-term follow-up and discussion of the role of graft pretreatment with modified host endothelial cells

Controversy remains regarding the effectiveness of EC/IC bypass for the prevention of stroke and the authors believe that some studies suggest that a subcategory of patients disabled by transient flow-related symptoms may benefit from surgery. The authors present a 7 1/2 year follow-up analysis of a patient who had undergone an EC/IC bypass from the proximal extracranial carotid to the middle cerebral artery using a 4 mm Gore-Tex prosthesis. Following his death from pulmonary sepsis, the graft was retrieved. Pathological and electron microscopic findings are reviewed.

Villaret's syndrome: A report of two cases

The syndrome resulting from lesions of the lower four cranial nerves (CN) and the cervical sympathetic chain is known as Villarets syndrome. We report two cases of the syndrome and emphasize the localizing value of this constellation of signs. The second case is unusual because involvement of the cervical sympathetic chain produced sympathetic overactivity, instead of the usual sympathectomy effect. Increased sympathetic outflow expressed as pupillary dilation, widened palpebral fissure, and facial sweating (the Claude Bernard syndrome) usually occurs as an early manifestation of apical thoracic tumors and has not been previously associated with Villarets syndrome.

Intracranial Metastases of Squamous Carcinoma via the Mandibular Branch of the Trigeminal Nerve

Squamous cell carcinoma commonly invades the perineural spaces of adjacent nerves; however, few cases of intracranial spread of tumor along this route have been reported. We present three cases of intracranial spread of squamous carcinoma along the mandibular branch of the trigeminal nerve. These cases illustrate the important clinical manifestations, difficulty of diagnosis, occasional unexpectedly long clinical course, and the difficulty of management of this problem.